A breathing space: how young Norwegian women engaging psychomotor physiotherapy to address long-term health disorders narrate their experiences

ABSTRACT

Introduction

In Norway, as elsewhere, young people may experience psychological distress and long-lasting pain. Such health disorders can be complex, leading some young people to seek psychomotor physiotherapy treatment. Thus far, however, there has been little qualitative investigation of their experiences.

Objective

The purpose of this study was to gain new knowledge about the illness experiences of young people with long-term health disorders engaging psychomotor physiotherapy.

Method

Qualitative interviews with ten Norwegian women aged 16–24 in psychomotor physiotherapy were analyzed within a narrative framework.

Findings

The participants’ treatment experiences take place in the context of a long history of pain, distress, and lack of understanding and support. Their stories tell of being threatened by illness and other difficult life events, and of being placed under further stress by a prolonged and disruptive quest for help within the healthcare system. For participants, psychomotor physiotherapy represents a breathing space where their illness experiences are acknowledged, enabling them to find rest and explore their bodily reactions and habits.

Conclusion

Long-term health disorders represent significant disruptions to the daily lives and relationships of young women. It is important to acknowledge the illness experiences of these young women and establish trustful therapeutic relationships. Psychomotor physiotherapy may offer significant potential as a means to help young people explore and make sense of their illness experiences.

KEYWORDS:

• Young
• psychomotor physiotherapy
• narrative
• health disorders
• pain

Introduction

In Norway, several studies have pointed to a rise in self-reported health complaints among young people over recent decades (Knapstad et al., 2021; Krokstad et al., 2022; Potrebny et al., 2019). Although findings are not unequivocal, they suggest that this trend is affecting girls to a greater extent than boys (Sletten and Bakken, 2016). While symptoms of psychological distress seem to have been increasing the most, significant numbers of young individuals report suffering pain in different parts of their bodies and making frequent use of painkillers (Bakken, 2022). Such pain can be long-lasting, with those suffering from it reporting a major impact on their everyday lives (Hoftun, Romundstad, Zwart, and Rygg, 2011). Moreover, young individuals who report having pain in one part of the body often report pain elsewhere, along with symptoms of psychological distress (Jahre et al., 2021). These findings underscore the complexity of these health issues.

Widespread explanations for such health-related trends among young Norwegians often focus on general trends in modern society, such as individualization, academic pressure, the rising need for self-discipline, pressures related to appearance ideals, and use of social media (Bakken, Sletten, and Eriksen, 2018; Eriksen, 2021; Eriksen, Sletten, Bakken, and Von Soest, 2017; Hegna, Ødegård, and Strandbu, 2013; Hellevik and Hellevik, 2021). Researchers in other Western countries have also proposed that societal and cultural developments characterized by individual pressure and uncertainty related to identity and belonging may be harmful to young people’s well-being (Eckersley, 2011). Some have argued that this social pressure affects young women more than men, as they must balance excelling in education and careers with conflicting societal expectations of “femininity” (Sweeting, West, Young, and Der, 2010; West and Sweeting, 2003).

The explanations presented above share some of the normative cultural notions and presentations around youth health propagated by Norway’s mass media. Such notions as “The Achievement Generation” and the female-specific “Good Girl Syndrome” present young people’s inability to cope with overwhelming pressures to perform in different areas of society as central to the development of health issues (Madsen, 2021). While these media descriptions appear to enjoy wide circulation in our culture, they have also attracted critical comments and analysis (Bakken, Sletten, and Eriksen, 2018; Løkke, 2021; Madsen, 2021; Nordtug and Engelsrud, 2016; Sletten, Rosten, and Vogt, 2021). Critics have pointed out that such characterizations as the “Achievement Generation” and the “Good Girl Syndrome” can contribute to pathologizing youth and further, imply that solutions lie in personal stress management and the development of life skills. In short, responsibility is largely placed on the individual, while contextual factors are downplayed (Madsen, 2021; Sletten, Rosten, and Vogt, 2021).

While far from complete, the above overview of perspectives highlights some key features of the complex and diverse discourses regarding health among young people in Norway. Importantly, it emphasizes the intricate connections between society, culture, and illness. This supports the investigation of illness in young individuals both as a subjective experience linked to an individual’s life and as an expression of cultural conditions that are common and shared.

This study aims to explore the complexity of young individuals’ illness experiences through the lens of psychomotor physiotherapy.¹ Psychomotor physiotherapy is a physiotherapy approach that seeks to bridge the gap between somatic, psychological, and social aspects of health, based on an understanding of the body as both biomechanics and as the embodiment of experiences (Ekerholt and Bergland, 2022; Thornquist and Bunkan, 1991).

The connections between muscle tensions, breath and emotions are central to the approach. In clinical practice, this entails that the physiotherapist and patient work together to explore and adjust the patient’s movements and bodily habits, and reflect on the patient’s health problems in the context of their past and present life (Thornquist, 2022). The aim is to increase the patient’s awareness of the body and factors involved in the development and maintenance of pain problems, to facilitate changes in bodily functions and habits (Thornquist and Bunkan, 1991). Increased awareness can reshape patients’ understanding of themselves and their interactions, hence it is considered crucial in empowering patients to enact changes in their daily lives (Dragesund and Øien, 2022; Ekerholt and Bergland, 2019). The treatment is often described as long-term, as this process is considered to require time.

Studies on the effect of psychomotor physiotherapy for patients struggling with long-term health issues suggest a positive impact on pain, anxiety, depression, insomnia, and fatigue, as well as improvement of health-related quality of life and self-esteem (Bergland, Olsen, and Ekerholt, 2018; Breitve, Hynninen, and Kvåle, 2010). Qualitative investigations of patients’ experiences of psychomotor physiotherapy suggest that through this treatment patients become more connected with their bodies and that the therapeutic relationship in psychomotor physiotherapy seems to hold the potential to enable change and the creation of new identities (Øien and Dragesund, 2022). Previous research highlights a lack of knowledge about young people’s experiences with psychomotor physiotherapy (Dragesund and Øien, 2023). A few recent master theses have explored this topic (Felde, 2021; Løvaas, 2021). However, more knowledge is needed about the experiences of young patients engaged in psychomotor physiotherapy and what meaning the treatment holds for them.

This study seeks to address this knowledge gap by exploring the illness experiences and needs of young people with long-lasting health disorders, thereby contributing to the development of effective strategies to help them. Specifically, this article sets out to investigate the following questions:

How do young individuals with long-lasting health disorders who are participating in psychomotor physiotherapy treatment narrate their illness experiences? In their stories, what meanings do they ascribe to psychomotor physiotherapy?

Theoretical perspectives

To explore the illness experiences of young individuals undergoing psychomotor physiotherapy treatment, we employ a narrative theoretical framework. Narrative can be described as a way of giving meaning to experience by which individuals make sense of themselves and the world (Polkinghorne, 1988). While there are various ways of defining what constitutes a narrative, one simple definition is that it is a series of events organized in a temporal structure (Riessman, 2008). The structuring of these events shapes a “plot” that often takes the form of a beginning, a middle, and an end. The meaning of each event is understood in terms of the structure of the whole story, while the meaning of the whole story is understood in terms of an overall understanding of specific events. In other words, through narration, events, and experiences are placed in a context that connects past, present, and future, toward achieving a meaningful whole. For people who are ill, the process of narration is thought to help them find meaning and connections between past events and present experiences, providing direction for future action (Charon, 2006; Frank, 2013). Arguing that illness narratives help patients build meaning and cope with illness, Frank also highlights the window they offer to researchers investigating how individuals experience and manage suffering in their daily lives (Frank, 2002, 2013).

While narratives contribute to understanding one`s own experiences, telling stories can also be regarded as a social act. Stories are told by someone, to someone, in a specific social, historical and cultural setting (Riessman, 2008). As individual narrators shape their narratives, they draw on what is culturally available and story their lives in recognizable ways (Holstein and Gubrium, 2000). This means that illness narratives should be seen against the background of the stories a culture makes available. Furthermore, narrative theory is concerned not only with how one gives meaning to experience but also with how one constructs a self through the telling of stories (Bruner, 1990; Frank, 2013).

Frank (2013: 53) claims that developing a coherent story about one’s illness is a way for ill people to repair the damage that illness has done to their sense of self, where they are in life, and where they may be going. According to Frank (2013), the self in illness narratives is not merely described; rather, the self is formed in what is told. This theoretical concept – that individuals actively shape a self through their stories – has inspired our analysis of the illness experiences of young people in psychomotor physiotherapy.

MATERIAL AND METHODS

This study forms part of a larger research project on psychomotor physiotherapy for young people, which includes interviews with patients and physiotherapists, as well as observations of clinical encounters. The empirical data for this article consists of qualitative interviews with ten young women undergoing psychomotor physiotherapy treatment in Norway.

Recruitment and participants

Patient participants were recruited through their treating physiotherapists, who also participated in the project. Nine psychomotor physiotherapists in primary health care services were recruited through key personas in the field facilitating contact, attending professional meetings, searching municipal websites, and posting on social media. The participating physiotherapists were asked to recruit among all of their current patients aged 16–25. This age span was chosen because it often forms a significant period in shaping an individual’s life, distinguished by profound changes and possibilities for exploring different life directions and identities (Arnett, 2000). The physiotherapists provided potential participants with an information letter containing contact information, and subsequent communication with patient participants was done with the first author via telephone.

Ten women aged 16–24 were recruited as participants. None of them were married or parents. All were currently undergoing treatment, the duration of which varied from a few weeks to over a year. Two participants were in treatment with the same physiotherapist.

Given our commitment to research that is inclusive and non-pathologizing, we avoided diagnostic labeling in the recruitment process and did not specify any health condition in our inclusion criteria. While the participants presented a range of different health issues, they shared certain issues: long-lasting pain in various parts of the body; feelings of unrest or anxiety; muscular tension; and sleep difficulties. Additionally, several participants mentioned fatigue, eating disorders, breathing problems, post-traumatic stress disorder (PTSD), digestive issues, depression, and challenges with trust and attachment. For further descriptive characteristics of participants, see Table 1.

Table 1. Descriptive characteristics of participants.

Fictive name	Sex, age	Social situation	Description of main health issue(s)
Charlotte	F, 24	Not working or studying, living alone	Fatigue, post-traumatic stress disorder (PTSD), multisite pain
Gina	F, 16	Student, living with parents (dual residence)	Anxiety, musculoskeletal pain
Ingrid	F, 17	Student, living alone	Musculoskeletal pain
Julie	F, 21	Working part-time, living with parents (two-parent household)	Fatigue, anxiety, multisite pain
Lena	F, 17	Student, living alone in student housing	Headache, migraine
Lisa	F, 22	Student, working part-time, living with fellow students	Multisite pain, irritable bowel syndrome (IBS), anxiety
Maria	F, 23	Not working or studying, living alone	Eating disorders, anxiety, depression, musculoskeletal pain
Nora	F, 20	Working part-time, living with parents (two-parent household)	Fatigue, multisite pain, anxiety, depression, eating disorder
Selma	F, 21	Sick leave from work, living with partner	Headache, fatigue, anxiety, PTSD
Susanne	F, 18	Student, working part-time, living with parents (two-parent household)	Breathing issues, anxiety, eating disorder

Ethical considerations

Norway’s Research Ethics Committee of Medicine (2022/481046) and the Norwegian Agency for Shared Services in Education and Research/NSD (2022/921538) approved the study. All participants gave informed written consent prior to interviews. It was emphasized that they had the right to withdraw at any time and that choosing whether to participate or not would have no impact on their treatment. Qualitative research interviews present a challenging ethical balance between building sufficient trust to be able to probe participants for potentially rich data, while at the same time maintaining sufficient distance in respect for the participant (Guillemin and Heggen, 2009). Being aware of this ethical challenge, the interviewer carefully considered the participants’ comfort and boundaries during interviews and refrained from pressuring them to share anything they seemed unwilling to. To ensure anonymity, participants have been given fictive names, and any potentially identifying information has been modified or omitted.

Interviews

The first author conducted the interviews in various locations across Norway. Participants were given a choice of interview locations. Most interviews took place in a private room at the treating physiotherapist’s office, scheduled directly before a clinical encounter that was observed for the larger project. Two participants opted for interviews in an offsite meeting room, and these were held at a conference center the day before the observation. Interviews lasted from 45 to 90 minutes.

An important principle of narrative research is that the interviewer should create a situation that allows a participant to speak about matters that are important to them (Riessman, 2008). Accordingly, the interviewer began the interview by asking the open question “Could you tell me a bit about yourself?” Riessman (2008, p. 24) asserts that narrative interviewing necessitates following participants down their trail. Accordingly, the interviewer asked open-ended questions to encourage the participants to elaborate on their experiences of illness and any other topics they chose to introduce. This was done to allow for the participants’ stories to unfold in unexpected ways. Throughout each interview, the interviewer attempted to follow the participant’s lead by asking follow-up questions such as “And then what happened?” or “Could you tell me more about that?” She asked for examples from their lives to gain rich descriptions of their experiences. If they did not bring it up themselves, participants were asked about their experiences with psychomotor physiotherapy. Aligned with Gubrium and Holstein (2003), our perspective is that the active engagement of both interviewer and participant leads to stories that are co-created.

All interviews were recorded and promptly transcribed by the first author. These transcriptions constitute the basis for our analysis. Participants’ accounts have been translated from Norwegian by the first author.

Analysis

Our narrative analysis was inspired by Riessman (2008) and guided by questions of “what” and “how.” This entails an analytical focus on both the thematic content, meaning what the stories are about, and the structure of the stories, meaning how different events and actions are connected to form a meaningful whole.

The process of analysis began with reading all the transcripts thoroughly to gain an overall impression of the young women’s illness experiences. Defining each interview as a story, we asked an overarching thematic question to each story: What is this story about? First, we identified themes within each story. Next, reading across the stories, we gradually identified themes that were repeated across the material; “Struggles to find explanations” and “Difficult life events.” Themes related to psychomotor physiotherapy treatment were “Exploration together with the physiotherapist” and “Being able to rest.”

In the third analytical step, we investigated how the individual stories were structured. This part of narrative analysis moves beyond what was said, to explore how the various events and actions are brought together to form a meaningful plot (Riessman, 2008). Next, reading across the material, we noticed common structural patterns. These patterns consisted of long illness trajectories characterized by repeated challenging interpersonal experiences. By situating psychomotor physiotherapy within the broader context of young women’s stories, their treatment experiences were given new meaning.

To present our findings, we developed a storyline that displays common patterns in themes, structure, and formation of selves from all the stories as a whole. The presentation of findings is substantiated with excerpts from the material.

Findings

Threatened selves: illness and other difficult life events

Despite their young age, the women speak of extensive experience of illness. Their stories often begin with phrases such as: “For as long as I can remember”, “Since I was a child,” or “I have always had troubles with … .” Thus, many of their illness stories do not seem to have a definitive starting point, nor do they display a clear division between life before and after the onset of illness. Illness is described as a major threatening presence in their lives, for many since early childhood.

While the young women describe various health issues, long-lasting pain and anxiety occupy a central place in most of their stories. Additionally, their stories refer to other difficult life events such as the loss of an important family member or friend, relocation, someone close to them getting injured or falling ill, or parental divorce. Some stories display feelings of insecurity resulting from acts of violence or unstable adult figures: difficulties that all appear to threaten the young women’s selves.

In the following account, Gina describes how the formerly stable foundations of her life were suddenly torn apart by parental divorce and family conflicts. Her account relates these events to feelings of anxiety:

It was a lot of things at once, happening so suddenly. I had a very predictable life. Continuity. Never any surprises considering my parents, no arguing. It was calm, very nice. I was always included in discussions and stuff like that; it was very proper. But then suddenly, it became so unpredictable (…) And then there was a lot of anxiety. (…) I found myself unable to trust anyone. I had a lot of sleeping difficulties, and because of that, I struggled to attend school. School suddenly became very scary. I developed a lot of anxiety related to school as well. (Gina)

While illness experiences are entwined with difficult life events in the young women’s stories, their accounts bring long-lasting illness and its impact on their lives to the fore. Pain and anxiety significantly limit their everyday lives. Their inability to form relationships or partake in the sort of social life usually enjoyed by young people is expressed as grief at how their lives have failed to turn out as hoped. Many accounts depict a state of not belonging or loneliness. As Julie tells it,

I avoid doing many things because I have a headache, or I know I will get a headache from doing them. I feel like that hinders me from doing a lot of things I want to do. I get very dejected and have periods where I feel like life is unfair (…) I felt quite alone when I was little. None of my friends seemed to understand, I had no one to talk to. It has influenced a lot of my upbringing, I think. There are a lot of things growing up that I couldn’t do. At a certain age, many begin to take the bus by themselves, or go to the mall or city with their friends, go to the beach in the summer and stay until nightfall, parties … *sighs* All those things have been impossible for me to do. I’ve been afraid. I don’t feel like I’ve had an adolescence really. Mostly because of anxiety, and somewhat because of migraines. (Julie)

While some participants mention support from family, many describe a general lack of understanding and support. When attempting to talk to family or friends about their suffering, the young women may find themselves simply being told to seek medical advice:

When speaking with friends, and at school … If someone asks how you are doing, you try to be a bit open. You’re often met with, “well, maybe you should take a trip to the doctor’s.” It’s kind of become normal, that when you’re hurting it may be something the doctor can help with. So, it becomes like, why not? (Lena)

In sum, the young women’s stories bear witness to selves that appear threatened not only by illness but also by other challenging life events. Nevertheless, illness takes center stage; it constitutes the major obstacle hindering the young women from partaking in daily activities, important relationships, and social events. With limited understanding and support from those around them, the women turn to healthcare services.

Troubled selves: a long and painful search for help

Struggling to make sense of their illness occupies a central place in the participants’ stories. Many describe a long sequence of medical assessments and treatment since early childhood. The search for explanations and solutions in the healthcare system appears to be driven by medical professionals, the young women themselves, and their parents. Often mothers play a central role in advocating for examinations and treatment, managing communication and appointments with healthcare professionals, as Julie describes:

I have certainly tried a lot [of health care], but then I got a clear message that there really isn’t much more to be done. So, I sort of settled with that for quite a while. But then, about two years ago, my mother told me “You can’t keep going like this. We have to try to figure this out now. Contact everyone we can, demand a bit more from the GP.” She’s been very much like that, not just accepting that there’s nothing to be done. (Julie)

Mothers often figure as helpers and protectors, guiding and supporting their daughters’ search for answers and access to medical care. However, this ongoing quest often fails to provide helpful answers or solutions. Many of the young women’s accounts portray selves that are placed on the sidelines as the medical quest itself becomes the center of attention. Medical language and diagnoses figure prominently in their accounts, which allude to a ceaseless flow of medical examinations, doctors’ visits, specialists’ assessments, hospitalizations, and diagnostic imaging, none of which seem capable of explaining their pain or discomfort. As Lisa puts it,

Since I was fifteen, I’ve had a lot of pain in my back. I’ve had everything checked out. They can’t seem to find out what the problem is, but it seems to be connected to the pain in my pelvis and my hip. And when I moved here at nineteen, my stomach started to hurt. A lot of constipation and nausea. So I had that checked out. I’ve had every examination – at the hospital, with specialists and all – and we still haven’t figured it out. They found I had endometriosis, but they don’t think that’s related to the other stuff. They also said IBS (irritable bowel syndrome). Some say this, some say that. No one really understands where it comes from (…) And the pain during intercourse, I’ve checked out everything there as well. I’ve been told you need to relax, or that it’s in my head (…) It has become like, I wonder if it’s just something I’m making up. I don`t recognize, and I almost don`t believe myself, in a way. (Lisa)

Lisa’s story underlines the limited help provided by many medical assessments and consultations. There is often a significant gap between the women’s illness experiences, the descriptions offered by healthcare professionals, and the treatment offered to them. Given the young women’s considerable trust in medical knowledge, they appear to find themselves under even greater strain when medical understandings and “solutions” misalign with their own experiences. They describe feelings of confusion and rejection when medical assessments fail to provide answers or when their problem is declared to be “psychological”. Moreover, their illness experiences don’t necessarily fit into common psychiatric categories either:

Don’t get me wrong, I have gotten help from BUP [mental healthcare services for children and adolescents]. But the frame is narrow. You must fit into a form. Sometimes I’ve had a very specific problem where these are the symptoms, this is the diagnosis, this is the treatment. But at times my problems have been unclear, not fitting into those forms (…) And when it gets like that, we don’t really know what to do. (Julie)

Medical uncertainty, and the fact that their health problems are not readily categorized, restrict possibilities for help. Many stories display selves that are thrown back and forth within the healthcare system, often being shuttled between its somatic and psychiatric divisions. They describe frequent changes of medical personnel, short-lived treatment courses, and therapist relationships that end abruptly. Some accounts connect dismissal by healthcare professionals to other experiences of breach of trust and lack of security, resulting in a worsening of illness and a loss of confidence in healthcare and the prospects for recovery:

I was sent back and forth between therapists in my town, then to the hospital for a treatment program, and then back to my hometown. I felt I was given up on very easily (…) I had a stable psychologist for a few years, but she left. I was sent to the community mental health center, but they would not take me, so I was sent to an outpatient clinic (…) It wasn’t working, so I asked to see another therapist. I guess I was a bit demanding. They ended my treatment without referring me to anything, leaving me high and dry (…) Now, I keep up a façade, a wall, to protect myself from rejection. It’s easier to not become so emotionally invested in therapists, relationships, treatment facilities and stuff like that. I think I’m going to be disappointed and rejected anyway because it has happened so much. So, I think that has hurt me a lot. And it seems classical, in that it’s connected to the way I was rejected in my childhood. It all appears connected. (Maria)

In sum, the young women’s stories of former health care bear witness to troubled selves being thrown back and forth in a long and difficult search for understanding and support. Descriptions of being rejected by workers in the healthcare system become attached to previous experiences of rejection and lack of support in the young women’s stories, creating painful renderings of repeated disappointment and dismissal.

Sheltered selves: psychomotor physiotherapy as a breathing space

The young women often describe former treatment experiences in terms of having “tried everything,” before someone – often a general practitioner, a general physiotherapist, or a psychologist – recommends psychomotor physiotherapy.

In contrast with the health professionals they have previously encountered, they often describe their psychomotor physiotherapist as someone who acknowledges their illness experiences:

When I went to the psychologist and talked about this thing with my breath, I was like … But is it real? And does it really matter? Maybe I’m just holding my breath. It’s hard to explain. *sighs* I almost didn’t want to talk about the things I could sense and feel, because it felt almost like I was making it up (…) Not breathing down into my stomach, what even is that? I felt like maybe I was making it more of a problem than it really was. But then again, it is a real problem for me. And when I come here [psychomotor physiotherapy], I can feel how much easier it is to breathe. When we… well, I don’t know exactly what we did, but what we did anyway *laughs* I become more like, yes, it is something. It’s real. Not just in my head, then. (Lisa)

Through the example of breathing, this account demonstrates how the women’s illness experiences are validated and made real in psychomotor physiotherapy. While their accounts rarely describe the treatment in detail, it is often portrayed as a process of discovery that helps participants explore the meaning of their illness experiences. All the same, many participants state how difficult they find it to understand and describe what happens in treatment or put their finger on how it helps. While some accounts highlight the importance of conversation, others emphasize touch or movement. Often, however, it is the combination of conversation, movement, and touch in treatment that emerges as meaningful:

It’s been nice having a place to talk about things. I feel that [the physiotherapist] sort of understands. But also, not just sitting and talking about stuff. Because sometimes it feels like, yeah, here we are, sitting and chatting, but what’s the point? Like, nothing happens. So, she has for example given me some exercises, things that I can do if I feel tense, or these chest pains that I get. How to be more aware of my position, being able to loosen up, things like that (…) It feels more like I’m actually doing something, and something happens. We don’t just sit and talk, either. (Nora)

This account demonstrates how the participants actively engage with their physiotherapist in exploring movements and bodily habits in an effort to make sense of their illness experiences. Several stories present the physiotherapist as an important helping character who listens to the young women and explores different movements and positions with them. Descriptions of becoming more aware and connected to the body throughout the treatment process feature in many accounts. Sometimes such experiences are described as challenging, and psychomotor physiotherapy is described as “weird” or “unusual.” Here, participants emphasize the importance of having a lasting and trustful relationship with the therapist. This is seen as crucial to letting one’s guard down, releasing muscular tension, and being able to relax:

It has a lot to do with the therapist, for the experience [of treatment] (…) I’ve noticed I’m much more aware of my body now. At the time, I could never really rest, in a way. I could lie in bed but not relax my shoulders properly. So, this [psychomotor physiotherapy] became the only place during the week where I could rest my shoulders and know what it feels like to really relax. Everything kind of came to a stop for a while: I could take a step back and just breathe. This was the only place. Even if I went to a psychologist. I couldn’t rest there. It’s quite tiresome to bring forth topics and find new solutions. When I came here, I could kind of catch my breath. It gave me some hope. (Gina)

As Gina’s words demonstrate, psychomotor physiotherapy appears to represent a safe space where the young women can catch their breath and become more aware of their body and habits. The account demonstrates how psychomotor physiotherapy is given meaning as a place where the women are provided with an opportunity to rest, through releasing their muscular tension. However, as demonstrated in this account, the concept of finding rest extends beyond muscular relaxation, encompassing a moment of relief and hope amid their difficulties.

In sum, their stories portray psychomotor physiotherapy as a place where the young women’s selves find shelter. In this context, their illness experiences are acknowledged, and they become more aware of their bodily reactions and habits. Overall, psychomotor physiotherapy appears to represent a breathing space amid challenging experiences, underpinned by a trustful therapeutic relationship.

Discussion

The young women’s stories portray selves that are threatened by illness and other difficult life events. With limited understanding and support from those close to them, they find themselves steered toward healthcare services. The young women’s selves are further troubled by being thrown back and forth within the healthcare system in a long and difficult quest for explanations and help. In this context, psychomotor physiotherapy emerges as a breathing space that provides possibilities for rest and for exploring bodily reactions and habits. Their stories emphasize the importance of acknowledgment and trusting therapeutic relationships.

Our findings highlight pain and anxiety as major obstacles to the young women’s possibilities to participate socially and pursue the life they aspired to live. According to Frank (2013), illness is a crisis of the self as it significantly interrupts one’s life. As Bury (1982) notes, illness can disrupt our life story by introducing significant changes in daily life, relationships, and overall sense of self (Bury, 1982). However, our findings emphasize how the young women’s illness experiences are entwined with other big and small disruptions in their lives. Difficult life events such as parental separation, acts of violence, relocation, and social exclusion are central to the young women’s stories. This is in line with Honkasalo’s study of people’s experiences of chronic pain, where she argues that those living with chronic pain may experience continual disruptions, pain being one among many (Honkasalo, 2001).

Previous studies have highlighted intricate connections between young people struggling with persistent pain and their social interactions (Fegran et al., 2021; Forgeron et al., 2010; Jahre et al., 2022). Fegran et al. (2021) emphasize that living with pain has a powerful influence on many aspects of young people’s daily lives, from education to social life, and that young people’s pain expressions are influenced by culture, friends, and family (Fegran et al., 2021). Similarly, our findings underscore the complex entanglements between illness and social relationships. Additionally, our findings illuminate how difficult and disruptive experiences in the young women’s personal lives seem to be repeated in their healthcare journey.

The numerous challenging and short-lived healthcare interactions in the women’s past form a troublesome quest for understanding and support. According to Frank (2013), illness calls for storytelling as a way to make sense of one’s experiences and one’s self. Storytelling is “a way of drawing new maps and finding new destinations” (Frank, 2013: 53). Healthcare professionals and medical knowledge often hold a significant role in shaping the patient’s story (Charon, 2006; Frank, 2013; Kleinman, 1988). However, our findings show how the young women struggle to find straightforward medical explanations and solutions for their health issues. Such conditions are often called “medically unexplained symptoms” (Malterud, 2015). A prolonged struggle to gain an understanding of what is wrong seems to be a common experience among adolescents and adults who suffer from medically unexplained symptoms, as well as a lack of validation and support received from medical personnel and other people in their lives (Polakovská and Řiháček, 2021). Likewise, studies of the experiences of young individuals afflicted by long-term pain have shed light on the stigma, invalidation, and mistrust they endure (Defenderfer et al., 2018; Wakefield et al., 2022). Young people are often in a process of trying to clarify a sense of who they are, what they want, and what choices to make for their future (Arnett, 2000). In other words, there appears to be particularly much at stake in clinical encounters with young patients, given the significance such encounters may have in shaping their lives. In this context, our findings highlight how experiences of dismissal in healthcare encounters may hinder young women with long-term health disorders from developing a coherent story about themselves and their illness, thereby hindering them from finding new directions for their life.

Our findings highlight how the young women’s threatened and troubled selves appear to find shelter in psychomotor physiotherapy. Specifically, by situating psychomotor physiotherapy within the young women’s stories, our findings shed light on this treatment as offering them a breathing space amid challenging experiences. Previous studies on adult patients’ experiences with psychomotor physiotherapy have highlighted patients gaining new awareness and understanding of their bodies and themselves (Dragesund and Øien, 2022; Dragesund and Råheim, 2008; Øien, Iversen, and Stensland, 2007; Sviland, Råheim, and Martinsen, 2012). To be recognized by the physiotherapist seems to play a crucial role in this therapeutic process (Dragesund and Øien, 2022). Other studies have also shown that recognition by health professionals plays an important role in the recovery of adult women struggling with long-term pain (Steihaug, Ahlsen, and Malterud, 2002; Werner, Steihaug, and Malterud, 2003). Our study resonates with these former studies and emphasizes the therapeutic significance of acknowledgment and trust for young women with long-term health disorders.

Sviland, Martinsen, and Råheim (2018) have suggested that trustful relationships in psychomotor physiotherapy may support the development of new stories about one’s life and self. By offering a place where young people’s illness experiences can be acknowledged and explored, our findings highlight how psychomotor physiotherapy may assist young people in developing new stories about their illness and themselves. This, in turn, may aid them in discovering new possibilities for their future.

By highlighting the various difficulties posing threats to the young women’s selves, our findings bring nuance to dominant cultural narratives. Dominant cultural narratives of young people’s illness tend to feature individuals who are threatened by high ambitions and overwhelming pressures to “achieve,” and point toward individual self-care and stress management as solutions for their suffering (Madsen, 2021). Our findings rather underline the importance of young people’s relational experiences, emphasizing the importance of trustful and sustained therapeutic relationships. As such, our findings add substance to the current discourse about young people with long-term health disorders and their needs.

Methodological considerations

According to Riessman (2008), the trustworthiness of narrative studies pertains particularly to the stories told by participants, and the stories told by researchers. During interviews, the context and interviewer significantly shape the participants’ stories (Gubrium and Holstein, 2003). Regarding the limitations of this study, we recognize that recruiting patient participants through treating physiotherapists may have led to the inclusion of satisfied patients with whom the physiotherapists had good relationships. The fact that the interviewer shared her professional background in psychomotor physiotherapy may also have encouraged positive descriptions of this approach. Acknowledging that these aspects of our study may have contributed to a favorable presentation of psychomotor physiotherapy, our study still demonstrates challenges and nuances to participants’ treatment and contributes to a comprehensive understanding of their experiences. By asking open questions and encouraging participants to speak freely about matters that were important to them, measures were taken to create a situation where the participants could openly share their experiences. We acknowledge that the inclusion of more participants may have provided additional details and nuances to our data. However, our data exhibited richness and depth, and we found consistent patterns of threatened and troubled selves finding shelter in psychomotor physiotherapy.

Regarding the strengths of this study, we have explicitly documented methodological decisions, presented our theoretical perspectives, described the analytical approach, and substantiated our analyses with excerpts from the empirical material. Our interpretations took shape via a rigorous and reflective process involving the entire research group. Our research group consisted of four researchers with diverse professional backgrounds in physiotherapy and competence in various qualitative research methods. The first author (EG) and last author (BA) thoroughly read all the interviews and held essential roles in the analytical process. However, the remaining authors also read several interviews and participated in group discussions where they shared their analytical perspectives and critical reflections on drafts. The diverse perspectives within the group improved reflexivity by challenging individual interpretations and assumptions, thus strengthening our analysis.

Our participants too were diverse: While all female, they lived in different parts of Norway with varying ages, reasons for referral, family backgrounds, and educational levels. This heterogeneity allowed for diverse stories in which various experiences and forms of meaning-making could emerge.

As stories are composed and received in specific contexts, a narrative is inseparable from the conditions in which it is situated and constructed (Riessman, 2008). Psychomotor physiotherapy provides the specific context of our study. However, we suggest that this study contributes valuable insights into the illness experiences and needs of young women with long-term health disorders. These insights may assist the process of devising strategies to better address their needs and hold value to others who engage with young people navigating such challenges. This includes caregivers and various other professionals, such as general physiotherapists, medical practitioners, school personnel, psychologists, nurses, and social workers.

Conclusion

Our study highlights how young women with long-term health disorders are threatened by illness and other difficult experiences in their lives. Troublesome healthcare interactions place further stress on the women, hindering them from repairing the damage that illness has done to their sense of self and plans for the future. By offering a place where the young women’s illness experiences are acknowledged and given new meaning, psychomotor physiotherapy may assist them in developing new stories about their lives and themselves. This, in turn, may aid them in discovering new possibilities for the future. By emphasizing the significance of acknowledgment and trustful therapeutic relationships, our findings contribute valuable insights into the illness experiences and needs of young women with long-term health disorders and add nuance to dominant cultural discourses regarding youth health.

Acknowledgments

We wish to thank the Norwegian Fund for Post-Graduate Training in Physiotherapy for its financial support, our participants for sharing their stories, and their physiotherapists for helping us with recruitment. We would also like to thank our reference group, consisting of physiotherapists, young individuals with patient experience, and school health personnel, for sharing their valuable insights and advice during the process of planning and realizing this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Norwegian Fund for Post-Graduate Training in Physiotherapy [165441].

Notes

1. In this study, the term “psychomotor physiotherapy” refers specifically to Norwegian Psychomotor Physiotherapy, also known as NPMP. It is a specialized approach within physiotherapy that was developed through collaboration between psychiatrist Braatøy and physiotherapist Bülow Hansen in Norway during the 1950’s (Thornquist and Bunkan, 1991).